Ultra-low-dose computed tomography and its utility in wrist trauma in the emergency department.

BACKGROUND: The use and frequency of computed tomography (CT) are increasing day by day in emergency departments (ED). This increases the amount of radiation exposed. PURPOSE: To evaluate the image quality obtained by ultra-low-dose CT (ULDCT) in patients with suspected wrist fractures in the ED and to investigate whether it is an alternative to standard-dose CT (SDCT). MATERIAL AND METHODS: This is a study prospectively examining 336 patients who consulted the ED for wrist trauma. After exclusion criteria were applied, the patients were divided into the study and control groups. Then, SDCT (120 kVp and 100 mAs) and ULDCT (80 kVp and 5 mAs) wrist protocols were applied simultaneously. The images obtained were evaluated for image quality and fracture independently by a radiologist and an emergency medical specialist using a 5-point scale. RESULTS: The effective radiation dose calculated for the control group scans was 41.1 ± 2.1 µSv, whereas the effective radiation dose calculated for the study group scans was 0.5 ± 0.0 µSv. The effective radiation dose of the study group was significantly lower than that of the control group (P < 0.01). The CT images in the study group showed no significant differences in the mean image quality score between observer 1 and observer 2 (3.4 and 4.3, respectively; P = 0.58). Both observers could detect all fractures using the ULDCT images. CONCLUSION: ULDCT provides high-quality images in wrist traumas while reducing the radiation dose by approximately 98% compared to SDCT without any changes in diagnostic accuracy.

The effectiveness of intradermal sterile water injection for low back pain in the emergency department: A prospective, randomized controlled study.

AIM: Low back pain (LBP) is a common musculoskeletal complaint among emergency department (ED) admissions. In this study, it was aimed to compare the effectiveness of systemic treatment with intradermal sterile water injection (ISWI) treatment protocol combined with systemic therapy in patients with LBP of unclear chronicity. METHODS: A prospective randomized, unblinded, controlled clinical study was conducted on patients admitted to the ED for LBP of unclear chronicity. One hundred twelve patients were randomly assigned to two groups; Group ISWI (n = 56) administered ISWI in the LBP region of patients along with systemic intravenous dexketoprofen therapy, while the other group (n = 56) received only systemic intravenous dexketoprofen therapy. The treatment methods' effectiveness was compared by measuring the pain intensity with the Visual Analog Scale (VAS) at admission, 10th minutes, 20th minutes, 30th minutes, and 24 h later. Also, opioid and analgesic consumptions in 24 h after treatment and patient satisfactions were compared. RESULTS: In the treatment of LBP, ISWI treatment was found to be more effective in relieving pain than systemic therapy alone (p < 0.001). Also, it was observed that opioid consumption in the ED and analgesic consumption within 24 h after treatments were decreased in the ISWI group (p < 0.001). The patient satisfaction in the ED was statistically increased (p < 0.001). DISCUSSION: In this unblinded study, ISWI with systemic therapy improved pain outcomes more than systemic therapy alone. Further research is needed to determine whether this was due entirely to placebo effect.

Sexual dysfunction in patients after double-J catheterisation: A cross-sectional, prospective study.

OBJECTIVE: This study was conducted to examine sexual dysfunction in patients after double-J catheterisation. MATERIALS AND METHODS: This descriptive, cross-sectional and prospective study was conducted in a research and training hospital from June 2020 to February 2021. The data were collected from patients who visited the emergency clinic and were hospitalised in the urology clinic because of renal calculi. The study was completed with 192 patients. The data were collected using a patient introductory form, the International Index of Erectile Function (IIEF-15) and the 5-item Turkish version of the International Index of Erectile Function (IIEF-5). Then data were collected before double-J catheterisation, 1 month after catheterisation and a month after the catheter was removed. The data were evaluated using means, numbers, percentile distributions and the paired samples t test. RESULTS: The patients' sexual function was negatively affected by double-J catheterisation, and this negative effect persisted for a month after removal of the double-J catheter. The differences in the patients' mean IIEF scores and sub-dimension scores before and after double-J catheterisation were statistically significant (P Ë‚ 0.001). A month after the double-J catheter was removed, the difference between their mean IIEF-5 scores was statistically significant (P Ë‚ 0.001). No erectile dysfunction was found in 50.0% of the patients before double-J catheterisation. A month after the catheter was removed, erectile dysfunction was found at different levels in 88% of the patients, and severe erectile dysfunction was found in 60.9% of the patients. CONCLUSION: This study found that double-J catheterisation negatively affects patients' sexual function. Patients experience sexual dysfunction while the double-J catheter is in place and for a month after it is removed.

The compliance of emergency healthcare personnel with isolation precautions during the COVID-19 pandemic: A cross-sectional questionnaire study.

OBJECTIVES: Isolation precautions are very important for emergency personnel faced with this high risk. This is cross-sectional study carried out to determine the compliance of emergency healthcare personnel with isolation precautions during the COVID-19 pandemic. METHODS: The study was carried out in the Emergency Services department of Erzurum Atatürk University and Erzurum Regional Training and Research Hospital from May 2020 to June 2020. The study population comprised 184 healthcare professionals working in emergency services, and the sample comprised 138 healthcare professionals who agreed to participate in the study. Data were collected using the "Healthcare Professionals Sociodemographic Form" and the "Compliance with Isolation Precautions Scale". Percentage distribution, t test, variance analysis (ANOVA), Mann-Whitney U test and Kruskal-Wallis test were used to analyse the data. Permission to conduct the study was obtained from the ethics committee and the Ministry of Health. RESULTS: Of the participants, 58.7% were male, 37.7% had worked for 1-5 years, 31.2% were nurses and the mean age was 30.78 ± 7.17. Of the participants, 86.2% wanted to receive training on isolation precautions, 87% knew the type of isolation practiced, 81.2% were able to identify suspected patients and 84.1% knew suspected patients were put into isolation. The emergency healthcare personnel's mean score on the isolation precautions compliance scale was determined as 67.63 ± 4.64. CONCLUSION: It was concluded that the emergency healthcare personnel had high levels of knowledge about the COVID-19 pandemic; however, they had an average level of compliance with isolation precautions.

Correlation of osteopontin hormone with TIMI score and cardiac markers in patients with acute coronary syndrome presenting with chest pain.

AIM: Rapid evaluation of patients with acute coronary syndrome (ACS) attending the emergency service under emergency room conditions and using appropriate risk scoring would improve treatment success. Calcium levels accumulate in the tissue in people with coronary artery disease and this has been found to correlate with osteopontin levels in some studies. It is predicted that osteopontin level could be used as a biomarker to detect coronary artery calcification. In this study, we aimed to evaluate the use of osteopontin levels in the differential diagnosis of ACS in conjunction with cardiac troponin I (cTnI) levels, and HEART (history, ECG, age, risk factors, troponin) and thrombolysis in myocardial infarction (TIMI) scores in patients with chest pain who attended the emergency service. METHODS: This study was conducted as a prospective observational clinical study in the Department of Emergency Medicine, Faculty of Medicine, Ataturk University. There was a total of 90 participants, including 60 patients and 30 healthy individuals in the control group. All participants' demographic information, electrocardiography (ECG) findings, cTnI level, TIMI and HEART score, and osteopontin level were evaluated. RESULTS: The patients' mean age was 51.61 ± 17.56 years and 63.3% (n = 57) were male. The body mass index (BMI) of the patients was 25.63 ± 4.67 kg/m2. Patients with chest pain [CP(+)] and high cardiac troponin I levels [cTnl(+)] were found to be older and to have higher HEART and TIMI scores than individuals with CP(+) and normal cardiac troponin I levels [cTnl(-)] and the healthy control group (p < 0.001). While the HEART score was zero in 22 (24.4%) of the patients, the TIMI score was zero in 42 (46.7%). In terms of gender distribution, vital signs and serum osteopontin levels, there was no significant difference between the patient groups (p > 0.05). It was found that patients with CP(+) and cTnl(+) had a higher rate of ECG abnormalities than the CP(+) and cTnl (-) group and the healthy control group (p = 0.13 and p < 0.001, respectively). In 65 (72.2%) of the patients, the ECG results were normal. ST-segment elevation was detected in 13 (14.4%) patients. In our study, cTnl levels were found to be positively correlated with age (r = 0.624), BMI (r = 0.291), HEART score (r = 0.794) and TIMI score (r = 0.805) (p = 0.001, p = 0.005, p = 0.001 and p = 0.001, respectively). In our study, we discovered that osteopontin levels could not reach the differential diagnostic level for ST-elevation myocardial infarction or non-ST-elevation myocardial infarction. No statistically significant difference was found in osteopontin levels between the groups (p > 0.05). CONCLUSIONS: While very positive results were obtained in this approach to the ACS diagnosis using HEART and TIMI scores in patients with chest pain who attended the emergency service and were diagnosed with ACS, no significant results could be obtained regarding the use of osteopontin levels as a biomarker. More comprehensive, multicentre studies involving a large number of appropriately selected patients are considered to be necessary.

Pain, Sleep Disturbance and Smoking Among Patients with Covid-19 Presenting to the Emergency Department.

AIM: The study aimed to determine the pain, sleep disturbance, and smoking among patients with Covid-19 who were presented to emergency departments. METHOD: This descriptive research was conducted between November 2020 and December 2021. The study population comprised 400 patients with COVID-19 who were presented to emergency departments at Ataturk University Research Hospital and Erzurum City Hospital and who agreed to participate in the study. The data were collected by the researcher via face-to-face interviews. Personal Information Form, Fagerström Test for Nicotine Dependence, Insomnia Severity Index, and McGill Pain Scale Short Form were used to collect the data. Descriptive statistics were presented as number, percentage, mean, and standard deviation. Parametric and nonparametric methods (t-test, Kruskal-Wallis Variance, Mann-Whitney U test, and Analysis of Variance (ANOVA) were used to compare variables between the groups. Ethical approval was obtained from the relevant authority prior to data collection and oral consent was obtained from all patients. RESULTS: It was determined that 52.5% of the patients were smokers; 24% of the smokers reported a decrease in smoking after being diagnosed with COVID-19. Nicotine addiction was found to be higher in men, tradesmen, and patients aged 55-64 years. McGill pain scale emotional sub-dimension scores were higher in women, whereas the sensory sub-dimension scores were higher in married patients. McGill pain scale total scores were higher in women, unemployed patients, and those with chronic diseases. Insomnia severity index was higher in women, smokers, and patients in the age group of 65-75 years. CONCLUSION: According to the results of the present study, pain, smoking, and sleep disorders in patients diagnosed with COVID-19 were affected by socio-demographic characteristics.

The relationship between individuals' use of complementary and alternative medicine during the pandemic in Turkey and their attitudes towards perceived COVID-19 risk.

Introduction: The perceived COVID-19 risk may lead to the use of various complementary and alternative medicine (CAM) modalities to reduce the potential risks of this disease. This study was conducted to investigate the relationship between individuals' use of complementary and alternative medicine during the pandemic in Turkey and their attitudes towards perceived COVID-19 risk. Methods: The study was conducted in Turkey between November 2021 and March 2022 and 1003 individuals voluntarily participated. The Personal Information Form, Attitude Towards Holistic Complementary and Alternative Medicine Scale (HCAMS), and Perceived COVID-19 Risk Scale (PCRS) were used for data collection. To evaluate the data descriptive statistics, Pearson's correlation, and Cronbach's alpha reliability analysis were used. Results: In the study, 54.2% of the individuals were found to use CAM during the pandemic, and 56.2% believed that CAM practices were useful in preventing or recovering from COVID-19. It was revealed that 53.8% of the individuals drank herbal tea, 55.2% used religious and spiritual healing to manage, 6.6% used massage, and 10.1% applied aromatherapy. The mean total score of the HCAMS was 28.29 ± 4.99, and the mean total score of the perceived COVID-19 risk scale was 27.78 ± 6.35. A statistically significant positive correlation was identified between the CAM subscale and the emotional risk subscale (p < 0.05). Conclusion: Individuals had a positive attitude towards using CAM during the pandemic period, the risk perception of COVID-19 was high and CAM methods were widely used.The literature should be supported by increasing the current and scientific studies in which CAM methods are questioned and their benefits are investigated during epidemic periods.

Turkish Validity and Reliability Study of Jessa Atrial Fibrillation Knowledge Questionnaire (JAKQ).

OBJECTIVE: Atrial fibrillation (AF) is the most commonly encountered arhythmia in clinical practice and constitutes one-third of the hospitalizations related to cardiac dysrhythmia. Furthermore, it is the most common reason for hospital admissions involving dysrhythmia complaints and is associated with the decrease in quality of life, functional capacity, cardiac performance, and lifespan. MATERIALS AND METHODS: This methodological study, which aims to assess the validity and reliability of the JAKQ, was conducted with patients (n = 175) who were admitted to the emergency clinic of Atatürk University Research Hospital between December 2016 and June 2018 and who were diagnosed with atrial fibrillation and met the inclusion criteria. The data were collected using a "Personal Information Form" and the "Jessa Atrial Fibrillation Knowledge Questionnaire (JAKQ). RESULTS: The exploratory factor analysis carried out to determine the construct validity of the scale showed that it had a three-dimensional structure and that its factor loads were within the appropriate range. The internal consistency analyses of the scale revealed that the Cronbach's alpha coefficient was 0.84 and that the item-total score correlations were at an adequate level. The correlation value of the test-retest conducted to test the time invariance of the scale was found to be 0.87, and there was a statistically significant relationship between the two applications (P < .001). CONCLUSION: The study results showed that the structure of the Turkish version of the Jessa Atrial Fibrillation Questionnaire was similar to the structure of the original scale, that its validity and reliability were considerably high and that it could be used in Turkey.

Analysis of Incidentally Diagnosed Patients with Coronavirus Disease 2019 at the Emergency Department: Single-Center Clinical Experience.

OBJECTIVE: Asymptomatic patients with coronavirus disease 2019 can present with signs of various diseases to hospitals. We aimed to present patients who presented to the emergency department without any coronavirus disease 2019 symptoms and were incidentally diagnosed with coronavirus disease 2019 in addition to the diagnosis related to their complaints on presentation. MATERIALS AND METHODS: The study included patients presented to the emergency department of a hospital in Erzurum (Turkey) with non-coronavirus disease 2019 symptoms and were incidentally diagnosed with coronavirus disease 2019 on the basis of their chest computed tomography findings. The patients' primary diagnoses were evaluated, and a reverse transcriptase-polymerase chain reaction was performed to confirm the incidental coronavirus disease 2019 diagnoses. RESULTS: The 42 patients included in the study had various complaints, and the most common complaint was abdominal pain in 8 patients (19%). The other complaints were at different rates. The most common diagnose was ST-elevated myocardial infarction in 6 patients (14.3%), and the other diagnoses were rib fracture in 3 patients (7.1%) and other similar diseases in the remaining patients. CONCLUSION: Patients with highly the contagious coronavirus disease 2019 can sometimes be asymptomatic and can be incidentally diagnosed with coronavirus disease 2019 after presenting to emergency departments with symptoms and manifestations other than those of coronavirus disease 2019. Therefore, healthcare professionals working in the emergency department should approach all patients who present to the emergency service as potential coronavirus disease 2019 carriers and wear their protective equipment and take necessary precautions.

The effects of progressive muscle relaxation exercises on the anxiety and sleep quality of patients with COVID-19: A randomized controlled study.

PURPOSE: This study aimed to determine the effects of progressive muscle relaxation exercises on the anxiety and sleep quality of patients with coronavirus disease 2019 (COVID-19). MATERIALS AND METHODS: This is an experimental study. Its data were collected in the infectious diseases clinic of a research hospital from May to August, 2020. This study was carried out with 67 COVID-19 patients (33 in the experimental group and 34 in the control group). The data were collected using a personal information form, the state-trait anxiety inventory, and the Richards-Campbell Sleep Questionnaire. The progressive muscle relaxation exercises were performed twice a day for 5 days with the researcher's supervision. The data were analyzed using means, numbers, percentage distributions, the χ 2 test, the dependent t test, and the independent t test. RESULTS: Statistically significant differences were found between the experimental and control groups' mean posttest scores on the State-Trait Anxiety Inventory and the Richards-Campbell Sleep Questionnaire (p < 0.05). The in-group comparison of the experimental group found a statistically significant difference between their mean pretest and posttest scores on the State Anxiety Scale (p < 0.05). The in-group comparison of the control group found no statistically significant changes in their mean pretest and posttest scores on the State Anxiety Scale (p > 0.05). CONCLUSION: The progressive muscle relaxation exercises effectively reduced the anxiety and improved the sleep quality of patients with COVID-19.

A rare chemical burn due to Ranunculus arvensis: three case reports.

Ranunculus arvensis, a plant that is a member of Ranunculaceae family, generally used for local treatment of joint pain, muscle pain, burns, lacerations, edema, abscess drainage, hemorrhoids, and warts among the population. In this case report, we presented three patients who developed chemical skin burns after using R. arvensis plant locally for knee pain. The destructive effect of the plant has been reported previously to be more in fresh plants and less in dried plants. Although protoanemonin, which is considered as the main toxic substance, was reported to be absent in dried or boiled plants, the plant was boiled, cooled, and wrapped over the region with pain in our cases. Therefore, we thought that protoanemonin may be considered to be heat resistant. Also, the burn management proceeded up to surgery by using the flap technique in one of our patients in contrast to the cases found in published reports who were treated by antibiotics and dressings.